A 10-year contract that provided funding for the non-emergency treatment of poor people in the Lower Keys has ended, and will force those patients to make tough decisions about procedures ranging from simple blood tests to cancer treatments.

When Health Management Associates took over the lease of Lower Keys Medical Center a decade ago, the company agreed to set aside $2 million a year for 10 years to pay the hospital as well as participating doctors for the care of low-income patients without insurance.

Will said the hospital will continue to operate its primary care clinic two days a week at dePoo Hospital. And the hospital, by law, is required to treat anyone who comes into its emergency room.

Elective surgeries, blood tests or lab results no longer will be covered by the indigent care fund. Also, most cancer services also are not considered emergencies, and indigent patients now will have to have a payment plan in place before they can have certain procedures, tests or chemotherapy.

Some drug companies work with the clinic and cancer patients to provide free chemotherapy and other drugs, Will added.

She emphasized that cancer is not an emergency, citing for example a man who goes to the primary care clinic with a bad knee.

"They would get a referral for knee surgery," Will said. "In the past, the physicians and the hospital would receive payment from this designated fund for the surgery, but that is no longer the case."

Some money remains to pay physicians for their services in cases like the knee surgery, but there is nothing left for the hospital, Will said.

"And we already provide $20 to $30 million in free care every year," she said, acknowledging that "people may have to make different decisions when it comes to elective surgeries and other procedures. Our county has one of the highest indigent populations in the state."

Indigent refers to people without insurance who cannot afford to pay for health care.

Some people may not get a preventive screening if they cannot afford it, Will acknowledged. Those screenings, such as colonoscopies, can prevent more serious and costly hospital services.

"Now the patient will be told up front what the payments will be, and a payment plan can be formed," she said. "Then the patient can decide what to do and whether to proceed."

There has been minimal discussion of renewing the fund, but no decisions have been made, Will said, adding she is keeping a close eye on the Obama administration and possible changes to the nation's health care system.

The hospital recommends that people have their own family physicians rather than visiting the emergency room for minor injuries or illnesses. Those without a family doctor can go to the primary care clinic on Tuesdays or Saturdays, but now may have to pay for services other than an exam.

The primary care clinic, run by Dr. Jerome Covington, can prescribe medicine, Will said, and the clinic staff will help patients enroll in free programs or for discounted prescriptions.